Resilience does not explain the dissociation between chronic pain and physical activity in South Africans living with HIV

Abstract

Pain burden is high in people living with HIV (PLWH), but the effect of this pain on functionality is equivocal. Resilience, the ability to cope with adversity, may promote adaptation to pain, so we hypothesised that higher resilience would correlate with less pain-related impairment of activity. We recruited 197 black South African PLWH, 99 with chronic pain (CP) and 98 patients without. We measured pain intensity and interference using the Brief Pain Inventory, and resilience using the Resilience Scale. Participants were generally highly resilient. Greater resilience correlated with better health-related quality of life, but not with pain intensity or interference. We also measured physical activity objectively, by actigraphy, in a subset of patients (37 with chronic pain and 31 without chronic pain), who wore accelerometers for two weeks. There was no difference in duration or intensity of activity between those with and without pain, and activity was not associated with resilience. In this sample, pain was not associated with altered physical activity. Resilience did not explain differences in pain intensity or pain interference but was associated with improved quality of life. Financial stresses and the fear of HIV stigma may have driven patients to conceal pain and to suppress its expected impairment of activity.

A preliminary analysis of the association between perceived stigma and HIV-related pain

“…Thus, catastrophizing, anxiety and social support may be psychosocial factors worth including in future studies of HIV stigma and pain. Additionally, recent work suggested that PLWH and chronic pain may maintain their activity levels despite high pain intensity in order to avoid HIV stigma (8).…”

“…All statements are rated in terms of how often they have occurred in the last three months: 'never', 'once or twice', 'several times', 'most of the time'. The sections can be further divided into six subsections: 'verbal abuse' (Q4, 9, 10, 11-13, 15, 19), 'negative self-perception' (Q29-Q33), 'healthcare neglect' (Q22-Q28), 'social isolation' (Q7, 8,[16][17][18], 'fear of contagion' (Q1-3, 5, 6, 14), and 'workplace stigma' (Q20- 21). A mean of the scores for each subsection gives a score of zero to three for each subsection.…”

“…We recently reported that, in contrast to behaviours seen in many other chronic pain states, patients with chronic HIV-related pain reported not disclosing their pain to friends and family (8). The reason for this behaviour was that revealing their pain status may reveal their HIV status and the participants feared that this would lead to them being stigmatised (8).…”

TNF-Block Genotypes Influence Susceptibility to HIV-Associated Sensory Neuropathy in Indonesians and South Africans

“…It predominately affects nerve fibers that innervate the distal limbs, particularly the feet [1]. Symptoms include pain, burning and numbness, which impact an individual's quality of life and ability to work [2,3]. Nucleoside reverse transcriptase inhibitors (NRTI) are effective anti-retroviral therapies (ART) but some, most notably stavudine (d4T), have severe adverse effects, including sensory neuropathy and lipodystrophy [4].…”

Polymorphisms in P2X4R and CAMKK2 may affect TNFα production: Implications for a role in HIV-associated sensory neuropathy

“…It is a length-dependant disease predominately affecting the nerve fibres that innervate the distal limbs, particularly the feet [1]. Symptoms include pain, burning, and numbness, which impact an individual's quality of life and work capabilities [2,3]. Susceptibility has been linked to single nucleotide polymorphisms (SNPs) and haplotypes in the P2X4R and CAMKK2 genes in patients of African descent [4].…”